Module 12 Cholesterol & Triglycerides Flashcards
1
Q
Coronary Heart Disease
A
- Coronary blood circulation
- Fails to supply heart with blood
- Caused by atherosclerosis
2
Q
Atherosclerosis
A
- Plaque build up in artery walls
- Narrow arteries
- Decrease flow to heart
- Inflammatory process
3
Q
Cholesterol Role
A
- Cell membrane
- Precursor of steroid hormones
- Precursor of bile salts
4
Q
Lipoprotein Structure
A
- Phospholipid shell (hydrophilic)
- Cholesterol & triglyceride core
5
Q
Lipoprotein Function
A
- Transport cholesterol & triglycerides into blood
- Require lipoproteins for blood solubility
6
Q
Apolipoproteins
A
- Embedded in phospholipid shell
7
Q
Apolipoprotein A-I
A
- Transport cholesterol
- Non-hepatic tissue to liver
8
Q
Apolipoprotein B-100
A
- Transport cholesterol to non-hepatic tissue
- Bind & transfer triglyceride to cells
9
Q
Apolipoprotein Functions
A
- Recognition by cells bind/ingest lipoproteins
- Activate metabolizing enzymes of lipoproteins
- Increase stability of lipoproteins
10
Q
Lipoprotein Classification
A
- Based on density
- High protein content = more dense
11
Q
Very Low Density Lipoproteins (VLDL)
A
- Deliver triglycerides for liver to fat/muscle
- Triglyceride core
- Majority of triglyceride in blood
- Apolipoprotein B-100 molecule
12
Q
Low Density Lipoproteins (LDL)
A
- Deliver cholesterol to non-hepatic tissue
- Cholesterol rich core
- Apolipoprotein B-100 molecule
- Increases coronary heart disease risk
- Bad cholesterol
13
Q
LDL Role in Atherosclerosis
A
- Promote initiation
- LDL move from blood to sub-endothelial space
- Oxidation of LDL causes recruitment of monocytes
- Convert to macrophages
- Macrophages take up oxidized LDL
- Create fatty streak, atherosclerotic lesion
14
Q
Atherosclerotic Lesion
A
- Lipid core
- Tough fibrous plaque
15
Q
High Density Lipoproteins (HDL)
A
- Cholesterol back to liver, promote removal
- Cholesterol core, minority of total
- Decreases coronary heart disease risk
- Apolipoproteins AI, AII, AIV
- Good cholesterol
16
Q
Cholesterol Testing Recommendations
A
- Have diabetes
- Have heart disease (includes fam history)
- Have hypertension
- Have central obesity
- Smoke (includes recent cessation)
- Inflammatory/renal disease
17
Q
Cardiovascular Risk Assessment
A
- Framingham risk score (FRS)
- 10 year risk of developing coronary heart disease
- Score above 20% high risk
- Score below 10% low risk
18
Q
Framingham Risk Assessment (FRS)
A
- Age
- Total blood cholesterol
- Smoking
- HDL cholesterol
- Systolic blood pressure
19
Q
Metabolic Syndrome
A
- Combination of disorders (3+)
- Increases risk of coronary heart disease
20
Q
Disorders Associated with Metabolic Syndrome
A
- Central obesity
- Elevated triglycerides
- Low HDL cholesterol
- Hyperglycemia
- Hypertension
21
Q
Non-Drug Treatment of LDL
A
- Diet
- Weight control
- Exercise
- Cigarette smoking
22
Q
Diet
A
- Decrease LDL cholesterol
- Establish healthy body weight
- Decrease cholesterol & saturated fat intake
23
Q
Weight Control
A
- Lowers LDL cholesterol
- Decreases coronary heart disease risk
- Dietary & exercise modification
24
Q
Exercise
A
- Decrease LDL cholesterol
- Elevate HDL cholesterol
- Decrease insulin resistance
- Decrease blood pressure
- 30-60 mins/day
25
Q
Cigarette Smoking
A
- Decreases HDL cholesterol
- Increases LDL cholesterol
26
Q
Elevated Lipid Treatment
A
- Stains
- Bile acid sequestrants
- Nicotinic acid
- Cholesterol absorption inhibitors
- Fibric acid derivatives
27
Q
Cholesterol Synthesis
A
- Majority occurs in liver
- Mevalonic acid pathway
- Greatest at night
28
Q
Mevalonic Acid Pathway
A
- Acetyl CoA
- HMG CoA
- Mevalonic acid (HMG CoA reductase enzyme)
- Multiple other products
- Cholesterol
29
Q
Stains Actions
A
- Decrease hepatic synthesis of cholesterol
- Inhibit HMG CoA reductase enzyme
- Upregulation of hepatic LDL receptors
- Liver removes more cholesterol from blood
30
Q
Stains Benefits
A
- Decrease LDL
- Increase HDL
- Decrease triglycerides
31
Q
Primary Prevention Studies
A
- Prevent development of cardiovascular disease
- Stains work as primary prevention
- Decrease coronary events
32
Q
Secondary Prevention Studies
A
- Prevent recurrence of cardiovascular events
33
Q
Atorvastatin
A
- Low oral bioavailability
- Majority absorbed by liver
- Remaining distributed to spleen, adrenal glands, skeletal muscle
- Metabolized by CYP3A4
- Eliminated in feces
34
Q
Rosuvastatin
A
- Low oral bioavailability
- Majority absorbed by liver
- Remaining distributed to skeletal muscle
- Minimal metabolized
- Eliminated in feces
- Higher concentrations in Asians
35
Q
Adverse Effects of Stains
A
- Muscle injury (myopathy)
- Muscle Lysis (Rhabdomyolysis)
- Hepatotoxicity
36
Q
Rhabdomyolysis Diagnosis
A
- Measuring blood levels of creatine kinase enzyme
- 10 times higher than normal
- Increase in blood potassium
- Acute kidney failure
37
Q
Nicotinic Acid (Niacin)
A
- Inhibits hepatic secretion of VLDL & LDL
- Increases HDL
38
Q
Nicotinic Acid Side Effects
A
- Facial flushing
- Hepatotoxicity
- Hyperglycemia
- Skin rash
- Increase uric acid levels
39
Q
Bile Acid Sequestrants
A
- Binding bile acids, prevent absorption
- Increase demand for bile acid synthesis in liver
- Require LDL, increase number of receptors
- Increase cholesterol uptake to liver
- Decrease plasma LDL levels
40
Q
Action of Bile Acid Sequestrants
A
- Binding bile acids, prevent absorption
- Increase demand for bile acid synthesis in liver
- Require LDL, increase number of receptors
- Increase cholesterol uptake to liver
- Decrease plasma LDL levels
41
Q
Adverse Effects of Bile Acid Sequestrants
A
- Not absorbed, no side effects
- Constipation & bloating
- Decrease drug absorption (digoxin, warfarin, antibiotics)
42
Q
Cholesterol Absorption Inhibitors
A
- Inhibit NPC1L1, ezetimibe with a statin
- Vytorin
43
Q
Ezetimibe Function
A
- Decrease intestinal absorption
- Lower LDL
- Increase hepatic synthesis
44
Q
Fibric Acid Derivatives (Fibrates)
A
- Decrease plasma triglycerides
- Increase HDL
- Increase lipoprotein lipase activity
45
Q
Action of Fibrates
A
- Binding & activating PPARa receptor in liver
46
Q
PPAra Activation
A
- Increase lipoprotein lipase synthesis
- Decrease apolipoprotein C-III
- Increase apolipoprotein A-I
47
Q
Adverse Effects of Fibrates
A
- Increase risk of gallstones
- Myopathy
- Hepatotoxicity
